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Disease of Pulp and Periradicular Tissue: an Overview

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Disease of Pulp and Periradicular Tissue: an Overview Journal of Current Medical Research and Opinion Received 16-09-2020 | Accepted 10-10-2020 | Published Online 11--10-2020 DOI: https://doi.org/10.15520/jcmro.v3i10.351 ISSN (O) 2589-8779 | (P) 2589-8760 CMRO 11 (10), 652−664 (2020) REVIEW ARTICLE Disease of Pulp and Periradicular Tissue: An Overview ∗ Geetanjali Singh1 Sanjana Paul R2 Ayush Arora3 Shakti Kumar4 Lucky Jindal5 Sachin Raina6 1Senior Lecturer, Department of Abstract: Prosthodontics, Crown, Bridge Dental pain is the most common reason due to which patient seek dental and Implantology, Himachal treatment. Pain occur due to diseases involving pulp and periradicular Dental College, Sundernagar, Himachal Pradesh tissues, as these tissues are richly innervated and have ample of blood supply. Also it is enclosed by surrounding tissues that are incapable 2Consultant Endodontist, Kanyakumari, Tamil Nadu of expanding, such as dentin and also has terminal blood flow and small-gauge circulatory access the periapex. All of these characteristics 3Consultant Dental Surgeon, severely constrain the defensive capacity of the pulp tissue when faced Jaipur, Rajasthan with the different aggressions it may be subjected to. In addition to above mentioned characterstics, pulp tissue can also be affected by a 4Consultant Orthodontist, Sirsa, Haryana retrograde infection, arising from the secondary canaliculi, from the periodontal ligament or from the apex during the course of periodontitis. 5Senior Lecturer, Department of Paedodontics and Preventive this review article basically concentrates on structure of pulp, classifi- Dentistry, JCD Dental College, cation of diseases related to pulp and periradicular tissue and detailed Sirsa, Haryana explanation of diseases. 6Intern, Himachal Institute of Dental Sciences, Paonta Sahib, Keywords: Abscess, Periodontitis, Pulp, Pulpitis Himachal Pradesh 1 INTRODUCTION Supplementary information The online version of ulp has been described as a highly resistant this article (https://doi.org/10.15520/jcmro.v3i10.35 organ and sometime as an organ with little 1) contains supplementary material, which is avail- Por no resistance as its resistance depends on able to authorized users. cellular activity, nutritional supply, age and other metabolic and physiologic parameters. (1) The dental Corresponding Author: Geetanjali Singh Senior Lecturer, Department of Prosthodontics, Crown, pulp consists of vascular connective tissue contained Bridge and Implantology, Himachal Dental College, within rigid dentin walls. (2) It is the principal source Sundernagar, Himachal Pradesh of pain within the mouth and also the major site of at- Email: [email protected] tention in endodontics and restorative treatment. (3) CMRO 11 (10), 652−664 CURRENT MEDICAL RESEARCH AND OPINION 652 Singh G et al. CURRENT MEDICAL RESEARCH AND OPINION Stimuli----> deposition of secondary dentin ----> reducing size of pulp chamber and volume-----> • Diagnostic method by – Tooth may disclose an enamel crack which may be better visualized by reduces the cellular, vascular and neural content of using a dye or transilluminating the tooth with the pulp results in atrophy (3) fibre optic light 2 DISCUSSION • Treatment-a full crown restoration immobilis- The first and foremost reaction of pulp tissue to ing the fragments. irritation is “Inflammation”, but the basic disease process that is involved in pulp and periapical disease is “Infection”. Infection can start from pulp and Barodontalgia spread to periodontal tissue and vice versa is also Toothache occuring at low atmospheric pressure. possible. (4) It occurs in high altitude. For example, in chronic Causes of Pulp Disease (5, 6) disease no symptoms occur at ground level but at high altitude pain occurs due to low atmospheric • Physical pressure. b) Thermal a) Mechanical 1. Trauma • Heat from cavity preparation , at either low or high speed A. Accidental (contact sports) – traumatic injury to pulp due to violent blow to the tooth during a • If there are deep fillings without protective base fight, sports or household accidents. Habits such as there will be conduction of heat. opening booby pins with the teeth and nail biting may also cause pulp injury. • Polishing of restoration will lead to production B. Iatrogenic dental procedures such as of frictional Heat • during excavation of carious tooth structure, c) Chemical cause- there might be accidental exposure of the pulp • Phosphoric acid and acrylic monomer etc. • Rapid movement of teeth by means of mechan- ical separator and during orthodontic treatment • Erosion by acids • The use of pins for mechanical retention of amalgam. d) Infection caused by bacteria and their by products enter pulp through- 2.Pathologic wear – attrition , abrasion etc 3.Crack tooth syndrome • Caries associated toxins. 4.Barodontalgia Crack Tooth Syndrome • Direct invasion of the pulp from caries or trauma • Incomplete fractures through the body of tooth. • Microbial colonization in pulp by blood borne micro organisms (anachoresis) • Symptom – pain ranging from mild to excrutiat- ing, at the initiation or release of biting pressure • Entry of bacteria through developmental groove CURRENT MEDICAL RESEARCH AND OPINION CMRO 11 (10), 652−664 (2020) 653 DISEASE OF PULP AND PERIRADICULAR TISSUE: AN OVERVIEW TABLE 1: Fibers associtaed with dental pain a. Dentinal hypersenstivity. b. Hyperemia. 2. Acute pulpalgia. a. Incipient. b. Moderate. c. Advanced. 3. Chronic pulpalgia. 4. Hyperplastic pulpitis. 1. Necrotic pulp. 2. Internal resorption. 3. Traumatic occlusion. 4. Incomplete fracture Classification (Weine) (10) • Inflammatory changes Pulp fibres associated with dental pain have been describes in Table 1 (7) 1. Hyperplastic (reversible pulpitis). Classification of Diseases of Pulp According to Grossman (8) a. Hypersenstive dentin. b. Hyperemia • Inflammatory diseases of dental pulp 1. Acute pulpalgia (acute pulpitis) (a) Reversible pulpitis 1. Symptomatic (acute) 2. Chronic pulpalgia (subacute pulpitis) 2. Asymptomatic (chronic) 3. Chronic pulpitis (b) Irreversible pulpitis 4. Chronic hyperplastic pulpitis 1. Acute – 1 abnormally responsive to cold 2 abnormally responsive to heat 5. Pulp necrosis 2. Chronic -1 Asymptomatic with pulp exposure B. Retrogressive changes 2 Hyper plastic pulpitis 3 Internal resorption 1. Atrophy 1. Pulp degeneration- 1.calcific 2. atrophic 2. Dystropic calcifications • Pulp necrosis Reversible Pulpitis (6, 10, 11) It is one of the earliest form of pulpitis and at one Classification (Ingles ) (9) time referred to as “pulp hyperaemia”. 1.Hyperreactive pulpalgia. Symptoms CMRO 11 (10), 652−664 (2020) CURRENT MEDICAL RESEARCH AND OPINION 654 Singh G et al. CURRENT MEDICAL RESEARCH AND OPINION • The pulp is inflamed to the extent that thermal stimuli- usually cold- cause a quick, sharp, hy- Irreversible Pulpitis (6, 11) persensitive response that subsides as soon as Is a persistent inflammatory condition of the pulp, stimulus is removed– symptomatic reversible symptomatic or asymptomatic, caused by noxious pulpitis. stimulus. Pain occurs spontaneously and it persists • Pain is not spontaneous. Occurs due to stimula- for several min to hrs and lingers on even after tion of A delta nerve fibres. removal of stimulus. Early symptoms • If the irritant is removed by sealing the tubules, pulp will revert to asymptomatic. Or if the symptoms persist, it leads to irreversible pulpi- • Pain is sharp, piercing, shooting and may be tis. intermittent or continuous which occurs due to stimulation of C- fibres. • Asymptomatic reversible pulpitis In later stages Histopathology There is capillary bed engorgement with oedema — • Pain is so severe in later stages and can be —prolonged vasodilation———increased capillary described as boring, gnawing, or throbbing. Its pressure——–increased vascular permeability——– intensity is increased by heat and sometimes increased blood volume———increased intrapulpal relieved by cold. Patients often kept awake at pressure——pain occurs. night by pain. Histopathology Diagnosis As decay reaches the pulp following changes are seen: • Pain short duration venules become congested causing necrosis— • Stimulus – required — necrosis attract PMN’s by chemotaxis—— -Acute inflammation——–phagocytosis———- • History - recent dental procedures PMN’s die ——-release lysozyme ———purulent • Percussion test - negative exudates———-microabcess is formed——pulp protects itself with fibrous connective tissue. • Referred pain - negative Microscopically, one sees the area of abscess, zone • On lying down pain - negative of necrotic tissue, with micro organisms present in the late carious state, along with lymphocytes, • Color change - negative plasma cells, macrophages. • Radiograph - normal Diagnosis • Vitality test - cold intensifies pain • Pain-Continuous &throbbing Treatment Prevention is best treatment .Periodic care is done to • Stimulus-Not required , spontaneous pain prevent development of caries. Use of cavity varnish • History-Deep caries, trauma , extensive restora- or base followed by proper filling and polishing. If tion pain persists even after removal of stimulus irre- versible pulpitis occurs- treated by pulp extirpation. • Percussion test-Positive CURRENT MEDICAL RESEARCH AND OPINION CMRO 11 (10), 652−664 (2020) 655 DISEASE OF PULP AND PERIRADICULAR TISSUE: AN OVERVIEW • Referred pain-Positive It is an idiopathic slow or fast progressive resorptive process occurring in the dentin of pulp chamber or • On lying down pain-positive root canals of tooth. It is painless condition stimu- lated by trauma
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